Health Sciences Regulatory Senior Consultant PRO-DRG

Health Sciences Regulatory Senior Consultant PRO-DRG Deloitte & Touche LLP's ("Deloitte & Touche's") Audit and Enterprise Risk Services business has a risk-based approach, experienced professionals, comprehensive methodologies, and technical resources. Deloitte & Touche provides integrated services including audit, control assurance, ''Regulatory and Capital markets'' consulting and enterprise risk management that identify risks and opportunities beyond the traditional financial reporting function.   Sound regulatory compliance practices may translate into more efficient, cost-effective, and transparent operations, demonstrating credibility to regulators, investors and analysts. Sweeping regulatory mandates, such as Sarbanes-Oxley, complicate matters by adding to the complexity already created by industry-specific regulations.     Deloitte & Touche is the largest risk management practice of its kind.  Our National Life Sciences and Health Care Regulatory service area is a global leader in delivering risk management solutions and performance improvement to a variety of life science companies and health care organizations.  As a result of our rapid growth, we are currently seeking qualified candidates for the positions of Senior Consultant and Consultant to join our teams in the Chicago, Boston, Costa Mesa, and Charlotte offices.   Responsibilities include: • Contribute to a strong client relationship through interactions with client personnel • Understand engagement as it relates to client's business • Demonstrate knowledge in some areas of industry or functional specialty • Contribute to engagement planning and ensuring that products/deliverables meet contract/workplan • Deliver services that meet Deloitte & Touche's task leader specifications • Contribute to a positive team attitude - BA/BS in Health Information Management, Nursing, Business or Accounting (MS/MA/MBA degree is a plus) - The ability to travel extensively is required. For the Regulatory PRO Group- General Compliance and Revenue Cycle Work: - Demonstrated subject matter experience of third party payer documentation, coding and billing rules and regulations.   Ideal candidate will have clinical (RN/LPN) with coding credential.  Demonstrated knowledge of: Correct Coding Initiative (CCI) Edits Clinical documentation requirements Coding proficiency ( CPT - services and supplies; ICD-9-CM- diagnosis coding) Coding and billing (chart to bill) audits Compliance Department auditoring and monitoring experience (hospital inpatient, outpatient and physician/professional fee) - Ability to evaluate professional and technical clinical documentation and charge capture opportunities  in  hospital ancillary departments,  clinics, and inpatient settings (acute care & academic medical organizations) Evaluate the sufficiency of clinical documentation to support charges billed to third party payers Identify documented,  unbilled services and supplies to improve professional fee and hospital department revenues Evaluate timeliness of charge capture & charge posting processes - Demonstrated coding proficiency with a minimum of 2 years industry experience: RHIA or RHIT, AHIMA credential CCS, AHIMA credential CPC-H or CPC-P; AAPC credential - Proficient written and oral communication skills to conduct training for physicians, nurses, coders  & charge posting staff on above topics For Clinical Documentation Practitioners: - Demonstrated coding proficiency with a minimum of 2 years industry experience: Ideal candidate will possess both a clinical (RN/LPN) AND  coding credential - focus on ICD-9-CM (Inpatient coding) Understanding of proposed APR or MS- DRG program & experience with APR-DRG 3M Grouper (State of Maryland) Ability to evaluate sufficiency of clinical documentation to support medical necessity, intensity of service, severity of illness and charges billed to third party payers. Proficient written and oral communication skills to conduct training for physicians, nurses, coders  & charge posting staff on documentation, coding and billing Coding Credentials  (see below under HIM Coder-BA or BS required if non RHIA) RN or LPN credentials ( if LPN or RN-BA or BS required additionally) - If not a dual credentialed candidate (RN/ HIM cert both), then HIM professional with the following credentials and a good understanding of inpatient coding, clinical documentation requirements (JCAHO, CMS COP,..) and reimbursement implications RHIA or RHIT; AHIMA credential Certified Coding Specialist (CCS); AHIMA credential Clinical nursing professional with strong, current inpatient care management and a good understanding of inpatient coding, clinical documentation requirements (as above) and reimbursement implications  as evidenced by following: Case Management / UR-UM experience Intensity of Service/ Severity of Illness (ISS) criteria (Interqual) Coding, CMI and LOS implications on DRG reimbursement Nurse Auditor experience in hospital setting- AMC most desirable Optional but desired for clinicians:Detailed knowledge of Quality of care indicators- current and proposed. Experience in QOC Indicators data collection and reporting optimal. Understanding of revenue cycle impacts to hospitals (and potentially physicians) as result of care outcomes, quality of care achievement scores. Experience in EMR development as it related to data capture/ fields utilized to capture key documentation elements for dx and px coding as well as QOC services or events. About DeloitteDeloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, and its network of member firms, each of which is a legally separate and independent entity. Please see www.deloitte.com/about for a detailed description of the legal structure of Deloitte Touche Tohmatsu and its member firms. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Deloitte LLP and its subsidiaries are equal opportunity employers.